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Concussion in Athletes

Individuals who participate in contact sports such as football, ice hockey, lacrosse and soccer have an increased risk of concussion. Much research has been conducted on concussion in athletes, yet there is still much to be learned. For instance:
• The risk of cognitive problems for soccer players is related to the number of confirmed concussions a player has sustained, more than to frequency heading the ball.
• In college football players, symptoms and signs of concussion disappear within days of an injury, but long-term consequences have not been measured in detail.
• It is not known with certainty if repeated head injuries that do not individually cause a definite concussion (so-called "subconcussive head injuries") may produce a cumulative injury with persistent, long-term or permanent cognitive impairment.
• In professional American football players, persistent post-concussive syndrome is increasingly reported but controlled demonstration of its specific relationship to concussions is hard to prove.
• Repeated concussions may increase the risk of developing Alzheimer's Disease in later life. This risk is presumably not limited to athletes, but some sports - American Professional Football and hockey - may expose players to higher risk of repeated concussions. This risk appears to be small and may be limited to people with a genetic susceptibility. There is much active research in this.

Guidelines for management of sports concussions may vary depending upon the age of the athlete, the risk of subsequent concussion in that sport, and the apparent severity of the concussion. No athlete should return to play on the day of the concussion, no matter how mild it seems.
The guidelines of the Zürich International Consensus provide a good model for gradual return to a sport after a head injury. They recommend:
• Moving from light aerobics to sport-specific exertion to noncontact training to contact training to full participation
• Being without symptoms at each level above before advancing to the next
• When baseline cognitive capacities have been measured, there should be return to that level before re-engaging in the sport
• Apply these rules to every concussion no matter how long recovery takes.

The existence of a specific degenerative brain disease in boxers called dementia pugilistica has long been known. This condition develops in proportion to the number of recorded injuries and the number of fights in which the boxer has participated. A similar illness is now referred to as chronic traumatic encephalopathy and has been found in professional American football players. This may be reflective of the increased player size, power, and armor in the modern game. The prevalence of chronic traumatic encephalopathy is not known. Potential genetic risk factors are being studied.
How relevant chronic traumatic encephalopathy is in terms of the general population of amateur athletes who have had one or two concussions is not known. We do know that we are not seeing an epidemic of premature dementia in former high school and college football players. In fact, several have been elected President of the United States!

Contact Information

Traumatic Brain Injury Clinic
Department of Neurology
Beth Israel Deaconess Medical Center
330 Brookline Avenue
Boston, MA 02215